Nimodipine after resuscitation from out-of-hospital ventricular fibrillation: a placebo-controlled, double-blind, randomized trial

Article Abstract:

After resuscitation from cardiac arrest (cessation of heartbeat), many patients die as a result of brain injury caused by oxygen deprivation (anoxia or ischemia) to that organ. More than 50 percent of resuscitated patients die in the hospital, and another one-fifth suffer brain injury. Drugs that protect against anoxic-ischemic brain injury (encephalopathy) may improve the prognosis of patients who suffer cardiac arrest. To evaluate this notion, a randomized, controlled study evaluated 155 Finnish patients who suffered ventricular fibrillation (VF, rapid, ineffectual cardiac action) in a non-hospital setting. In all cases, the patients underwent resuscitation from the physician-staffed Advanced Life Support Unit within 20 minutes of cardiac arrest. At the site of resuscitation, 75 patients received intravenous nimodipine (a drug that affects calcium entry into cells, a possible cause of cell death when the oxygen level is reduced), and 80 were given placebo. The drugs were given as single infusions, then as 24-hour continuous infusions. Patients were evaluated one year later with respect to survival and neurological and cognitive functions. Results showed that a similar proportion of patients in the nimodipine and placebo groups died during the first year after cardiac arrest (60 and 64 percent, respectively), with approximately one-third of all deaths due to anoxic encephalopathy. No differences were found between the two groups in their scores on a variety of cognitive and neurological tests. Most survivors functioned completely independently one year after their VF episode. Recurrent VF was more common during the treatment period among patients who received placebo, 12 episodes, compared with 1 in the nimodipine-treated patients. Nimodipine may have provided a beneficial effect for patients whose resuscitation was delayed. The study results have already prompted a large-scale European trial of nimodipine administration after resuscitation from cardiac arrest. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Mortality, Prevention, Complications and side effects, Ventricular fibrillation, Brain damage, Cardiac resuscitation

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Neuropsychological sequelae of cardiac arrest

Article Abstract:

Half of all patients in cardiac arrest who are successfully resuscitated will experience little if any neurological or psychological disturbances one year after the incident. Sixty-eight survivors of an out-of-hospital cardiac arrest were given a battery of intellectual, psychological and emotional tests three months after the incident; 54 were still alive one year after resuscitation and were tested again. Forty percent had minimal dysfunction at three months and 52% were in that category at one year. Thirty-five had been given an injection of nimodipine shortly after resuscitation followed by a 24-hour infusion. Thirty-three received a placebo, or inactive substance. Nimodipine appeared to have little effect on neuropsychological function. Of those who experienced some dysfunction, one-third suffered from depression at three months and one year. Impaired memory was also a common outcome.

Psychological aspects, Testing, Mental health

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Long-term outcome after intravenous thrombolysis of Basilar Artery Occlusion

Article Abstract:

Basilar artery occlusion is an infrequent disease with high morbidity and mortality. Outcome of patients with Basilar artery occlusion (BAO) treated with intravenous thrombolytic therapy is evaluated.

United States, Science & research, Care and treatment, Research, Thrombolytic therapy, Basilar artery

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